Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
I read with interest the article Strontium ranelate may cause
alopecia, by Sainz et al, which recently appeared in the BMJ (published
online 22 April 2009). Alopecia is often diagnosed during dermatological
consultation, but it may be difficult to distinguish from seasonal hair
loss and identify the cause in a single individual, particularly in the
absence of objective measures. Alopecia is frequently described and is
reported in between 15% to 30% of women aged over 30 (1) and nearly 50% of
women aged over 50 years (2). Indeed, alopecia has a number of known
causes, which include menopause, nutritional disorders, thyroid disorders,
anemia, iron deficiency, psychological stress, and alopecia areata, which
may be spontaneously reversible. Moreover, hair loss is associated with a
considerable number of widely used medications: anticoagulants,
cholesterol-lowering drugs (fibrates, statins), ACE inhibitors, Beta-
blockers, digitalics, antidepressants, antiepileptics, proton pump
inhibitors, NSAIDs, bronchodilators, antibiotics, benzodiazepines (3), and
recently 1720 spontaneous adverse reaction reports of alopecia in
association with alendronate were reported between July 1993 and January
2008 (4,5).
As the cause of alopecia is very difficult to determine due to the
many possible etiologies, the relationship with strontium ranelate
speculated in the above mentioned article needs to be confirmed by further
studies. In addition alopecia cannot be considered as a sign of the
syndrome of drug-induced hypersensitivity (6), which involves generalized
drug rash, fever, lymph node enlargement, and systemic involvement.
In conclusion, alopecia has been reported as a side effect of many
drugs, including antiosteoporotic treatments, though causality is often
difficult to establish; it cannot be considered as a symptom of drug-
induced hypersensitivity.
Yours sincerely,
P. Musette, MD, phD Dermatologist department, Rouen University hospital,
France
Answer to Sainz et al article
Dear Editor,
I read with interest the article Strontium ranelate may cause
alopecia, by Sainz et al, which recently appeared in the BMJ (published
online 22 April 2009). Alopecia is often diagnosed during dermatological
consultation, but it may be difficult to distinguish from seasonal hair
loss and identify the cause in a single individual, particularly in the
absence of objective measures. Alopecia is frequently described and is
reported in between 15% to 30% of women aged over 30 (1) and nearly 50% of
women aged over 50 years (2). Indeed, alopecia has a number of known
causes, which include menopause, nutritional disorders, thyroid disorders,
anemia, iron deficiency, psychological stress, and alopecia areata, which
may be spontaneously reversible. Moreover, hair loss is associated with a
considerable number of widely used medications: anticoagulants,
cholesterol-lowering drugs (fibrates, statins), ACE inhibitors, Beta-
blockers, digitalics, antidepressants, antiepileptics, proton pump
inhibitors, NSAIDs, bronchodilators, antibiotics, benzodiazepines (3), and
recently 1720 spontaneous adverse reaction reports of alopecia in
association with alendronate were reported between July 1993 and January
2008 (4,5).
As the cause of alopecia is very difficult to determine due to the
many possible etiologies, the relationship with strontium ranelate
speculated in the above mentioned article needs to be confirmed by further
studies. In addition alopecia cannot be considered as a sign of the
syndrome of drug-induced hypersensitivity (6), which involves generalized
drug rash, fever, lymph node enlargement, and systemic involvement.
In conclusion, alopecia has been reported as a side effect of many
drugs, including antiosteoporotic treatments, though causality is often
difficult to establish; it cannot be considered as a symptom of drug-
induced hypersensitivity.
Yours sincerely,
P. Musette, MD, phD Dermatologist department, Rouen University hospital,
France
References:
(1). Birch MP, Lalla SC, Messenger AG. Female pattern hair loss. Clin
Exp Dermatol. 2002;27:383-8.
(2). Rogers NE, Avram MR. J Am Acd Dematol. 2008;59:547-66.
(3). Litt JZ. Drug Eruption Reference Manual. 14th ed. Informa
Healthcare. 2008.
(4). European Medicines Agency. Fosavance. Summary of product
characteristics. Available at: http://www.emea.europa.eu. Accessed: 14 May
2009.
(5). European Public Assessment report revision 6- published
16.12.2008, procedural steps taken after authorization
(6). Valeyrie-Allanore L, Sassolas B, Roujeau JC. Drug-induced skin,
nail and hair disorders. Drug Safety. 2007;30:1011-30.
Competing interests:
None declared
Competing interests: No competing interests